Watts vs Mets

Watts vs Mets

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Jan 3 13 8:07 PM

Finally after several months of me complaining to the VA Cardiologist about shortness of breath on excersion, he sent me for a supine bicycle stress echocardiogram (back problems prevented thread mill). The results of the test show a table with Watts, not Mets. It was done in 4 statges at 3mins each (25, 50, 75 and 100 Watts). I exhibited dyspnea at 75 Watts, chest pain and dyspnea at 100 Watts.

I found a calulator online that converts Watts to Mets after you plug in your weight. For me at 75 Watts, when dyspnea was first noted, it converts to 3.9 Mets. At 100Watts, it converts to 4.5 Mets. At baseline (resting, lying down) my LVEF is 60-65%, at Peak Stress my LVEF is > 70%

Do the VA raters know how to convert Watts to Mets or do they just use LVEF? Depending on what they use it could be 60% or 30%. If they use LVEF and rate it at 30% do I have a valid argument?

If you read CFR 38, LVEF is not used if the LVEF is above 50. In that case Mets must be used. If the rater doesn't know how to convert from Watts he will ask the cardiologist. If your calculator is correct you should be 60%

That is conmforting to know... I see the Cardio doc Feb 5, I'll ask him to please note my medical file with a Mets value, thanks LouF.

In what situation, in your humble opinion of course, would LVEF not correspond to METs or Watts. I find it hard to believe, based on how I feel, that I'm 60-70% LVEF, which is supposed to be a perfectly normal LVEF. I'm assuming Echos are fairly accurate. I can walk one flight of stairs, but two, I'm trying to catch my breath at the top of the stairs. The dysnea on exhurtion is a new onset for me for the past 2-3 months.

LVEF measures how the left side of the heart is functioning, if you have significant right side damage it not always show but will on the stress. Also it could be a question of the amount of cardiomyopathy you have plus some other things. You need to ask the cardio why it is happening. Often the raters will look at the LVEF and give a wrong rating. In your case your LVEF is too high so according to the rules they must use METS. If you get a wrong rating then you have lots of grounds for at least a CUE at worst an NOD.

Rating the heart can be a little bit tricky in some cases for instance somebody may have a LVEF of 45% and METS of 4 which is by the book but if they have had 3 or more occurrences of CHF in a year then they should be rated 100% but it is rare that this can happen but it does

That's a moot point because they aren't supposed to do that. What they will likely do is to order a C&P exam and the examiner can either convert the previous findings to METs or do another test. That will be the examiner's call.

LouF wrote:
Rating the heart can be a little bit tricky in some cases for instance somebody may have a LVEF of 45% and METS of 4 which is by the book but if they have had 3 or more occurrences of CHF in a year then they should be rated 100% but it is rare that this can happen but it does

Actually Lou, speaking as someone who was a decision maker at VA, the heart is one of the easier body systems to rate. There is no hard and fast rule that says that 3 episodes of congestive heart failure is 100 percent. The question is whether the heart failure is acute or chronic, and that is for the doctor to say. In reality though, if someone does have that many episodes of congestive heart failure in one year, most likely the other evidence is going to point to a 100 percent evaluation.